Life After a Heart Attack

St. Vincent Cardiac Rehabilitation Program

If you’ve had a heart attack, knowing what to expect as you recover can be helpful and allay your fears. It’s good to know you’re not alone.

When a heart attack occurs, a part of the heart dies because its supply of oxygen-carrying blood is cut off. But the heart is a remarkably tough organ. Even though a part of it may have died, the rest still keeps working. Most heart attack victims survive their first heart attack. Most recover fully and enjoy many more years of productive activity.

Your situation is much like that of an athlete with a torn leg muscle. Until the heart muscle heals, your effectiveness is reduced. Because your heart has been damaged, it's weak and can't pump as much blood as usual.

During the first few days after a heart attack, rest is essential. Even after you rest, you should limit your activities until your heart has had time to heal. When your heart is healthy again, you can return to your usual lifestyle. Most people who've had a heart attack can resume their former activities in a few weeks or months.

As the damaged part of your heart heals, a tough scar forms. This takes time; it's still forming after you've begun to feel good again. Usually in a month or six weeks, your heart has repaired itself. The length of time depends on the extent of your injury and your own rate of healing. That's why doctors recommend different amounts of activity for each heart attack patient.

If you follow your doctor's recommendations regarding your weight, diet, exercise, work, medicine and rest, you'll have a better chance of living comfortably and avoiding another heart attack.

Exercise

If you rested a lot in the hospital and stayed in bed, you'll feel weak when you get home. Damage to your heart isn't the reason. You feel weak because inactive muscles lose their strength very quickly. Without activity, muscles lose 15 percent of their strength in just one week.

Muscles regain strength only through exercise. That's why your doctor has given you a program of gradually increasing activities you can do at home. It normally takes two to six weeks to get muscles back into shape even with regular exercise.

When your heart has healed, the scar usually isn't big enough to interfere with your heart's ability to pump blood. That means you won't need to reduce your activities very much (if at all), though you may need to make some lifestyle changes.

Most people who recover from a heart attack can take walks, play golf, fish, swim and enjoy similar activities with no trouble. In fact, physical activity is healthy and recommended for most heart attack survivors. Many times, doctors recommend that heart attack survivors get even more physical activity than they got before their event. Talk to your doctor to find out how much exercise is right for you.

Work

Between 80 and 90 percent of heart attack survivors return to work in two to three months. Most heart attack patients find they have plenty of energy for both work and leisure activities. Usually they can return to their former jobs.

Your return to work depends on two things: how badly your heart was damaged and how demanding your job is. Some people switch jobs and take a new job that's less taxing on their heart.

Whether you go back to work or not, make sure you rest before you get too tired. Getting a good night's rest is important for everyone, but it's especially important for heart attack survivors. Sometimes a nap or short rest period during the day is helpful, too. Your doctor can help you decide when it's OK for you to go back to work.

Emotional Health

You'll have a wide range of emotions after your heart attack. Time will cure most of your unpleasant feelings, but if things start to bother you, tell someone you trust how you feel. Don't just pretend nothing is wrong.

Three of the most common emotions are fear, anger and depression:

Fear. You may have thoughts like, "Am I going to die? Am I living on borrowed time? Will my chest pain or shortness of breath come back?" These are troubling thoughts, but as time passes, your worries will go away. Physical symptoms may cause fear, too. You probably never gave small, fleeting pains a second thought before your attack. Now, the tiniest twinge in your chest worries you. That's normal. The passing of time will ease these fears, too. One of your biggest fears may be that you won't be the same person you were before your heart attack. You may be afraid you won't be able to work as hard, be as vigorous, or be a helpful spouse or parent. You may even think that now it's too late to do all the things you've dreamed of doing. To some extent, everyone in your situation feels this way. But try not to anticipate the worst. Be patient, and give yourself a chance to recover.

Anger. You may think, "Why did this happen to me, and why did it have to happen now?" Bitterness is common after a heart attack. You may lose your patience with your friends and family, or they may irritate you. Before you snap at them, remember that it's normal to feel resentment a heart attack, and your misfortune isn't their fault.

Depression. You may be depressed or "have the blues." You may think you're hopelessly damaged or crippled. You may even have thoughts like, "What's the use? Life is over." This, too, is normal. If you think you may be depressed, tell your doctor. He or she can evaluate your symptoms to determine if you need additional help or treatment. Signs and symptoms of depression include:

Sleep problems. You have trouble sleeping or you want to sleep all the time.

Emotional stress. You're tense, irritable or agitated, or you feel listless and apathetic.

Loss of alertness. You have trouble concentrating.

Apathy. You lose interest in your old hobbies

Low self-esteem. You feel worthless or inadequate.

Despair. You have repeated thoughts of death or suicide.

Sloppiness. You don't keep up your appearance or clean up after yourself.

Chest Pain

Not everyone has chest pain (angina pectoris) after a heart attack. In fact, many people don't. But it's possible that you will.

Angina is a light pain or pressure in the chest that occurs when part of your heart muscle doesn't get enough blood (oxygen) for the work it has to do. That's why angina usually occurs during or right after physical exertion, intense emotion or eating a heavy meal.

If you do have angina attacks, tell your doctor. He or she can prescribe medication or an exercise program to help you.

Sex

Most people can continue their same pattern of sexual activity after they recover from a heart attack. If you or your sexual partner are worried about this, talk to your doctor. If you get angina when you exert yourself during sex, your doctor may prescribe nitroglycerin for you to take before sexual activity.

Smoking

If you smoke, quit now. If you resume smoking, your chances of having a second heart attack are doubled.

Smoking increases the strain on your heart because it causes blood vessels to constrict, and some of them are already narrowed and damaged. Smoking also causes your heart to beat faster and raises your blood pressure. Finally, smoking increases the level of carbon monoxide in your blood, depriving your heart of the oxygen it needs.

Diet and Weight Management

It's important for people with heart disease to keep their weight in a healthy range. It's also important to eat a well-balanced diet that contains healthy amounts of protein, vitamins and minerals. Your diet should also be consistent with the American Heart Association Diet, which is low in saturated fat, cholesterol, total fat and sodium.

The goal of a fat-controlled diet is to reduce your blood cholesterol. This lowers your risk of heart attack. The diet will help you cut down on calories from fat, particularly from meat, high-fat dairy and saturated fats. You need to focus on reducing your saturated fat intake, which will help lower your dietary cholesterol intake at the same time.

You'll probably be reducing the fat in your diet to less than 30 percent of total calories. To make up for the decrease, you'll need to eat slightly more carbohydrates. Ideally, your carbohydrates should come from fruits, vegetables and cereals.

Alcohol

The American Heart Association recommends no more than one drink a day for women and two drinks a day for men. If you're trying to lose weight, remember that alcoholic beverages are high in calories.

Medications

Your doctor may prescribe anticoagulant drugs depending on the circumstances of your heart attack. Anticoagulants interfere with the normal clotting of blood. They're prescribed to prevent blood clots that may occur in a coronary artery or leg vein.

In most cases, anticoagulants are beneficial. In other cases, they're not needed. Only your doctor should decide if anticoagulants are right for you. If your doctor prescribes them, you'll need blood tests to ensure that the proper dosage is maintained. You should also carry a card stating the anticoagulant drug and dosage in case you're involved in an accident.

In addition to anticoagulants, your doctor may recommend taking aspirin regularly to help prevent another heart attack.